We talk a lot about performance when it comes to young athletes. Getting faster, stronger, making varsity, earning a starting spot on their team, and competing at the next level. However, there’s something I wish we talked about more… bone health in young athletes.
While we’re busy helping teenage athletes improve their performance, their bodies are doing something hugely important behind the scenes… GROWING.
Adolescence is one of the most important windows of opportunity they’ll ever have to build strong, healthy bones. Yet, we’re still seeing young athletes being encouraged to lose weight, change their body composition, restrict certain foods, or eat less in pursuit of better performance.
Sometimes those recommendations come from well-meaning adults who genuinely believe they’re helping.
But as a provider that’s worked with athletes for years, here’s what I want parents, coaches, and providers to understand…
Adolescence isn’t the time to manipulate an athlete’s growing body in pursuit of an “ideal” athletic body.
We’re not just influencing how they perform this season. We’re helping build the skeleton they’ll have to live with for decades.
Your Teenage Athlete Isn’t a Smaller Adult
One of the biggest mistakes we can make when working with young athletes is treating them like smaller versions of adults.
They’re not.
A teenage athlete may be training at a high level, competing against older athletes, or following a structured strength and conditioning program.
But physiologically, they’re still developing.
Their bodies are navigating puberty, hormonal changes, growth spurts, and skeletal development.
And guess what? All of that requires energy.
Now add practices, games, competitions, strength training, conditioning, school, and everything else that comes with being a teenager.
That’s a LOT of demand on a developing young body.
Young athletes don’t just need enough energy to support their training. They need enough energy to support their training AND their growth.
Those are two very different things.
When we overlook that distinction, we can unintentionally compromise the very development we’re trying to support.
Adolescence Is a Critical Window for Building Peak Bone Mass
Let’s talk about why this stage of life matters so much for bone health.
Bone isn’t simply a rigid structure that holds the body together.
It’s living, metabolically active tissue that’s constantly being broken down and rebuilt.
Throughout childhood and adolescence, the skeleton is also growing and developing.
Puberty is a particularly important period for increases in bone size, density, and strength.
This process contributes to what we call peak bone mass, or the maximum amount of bone tissue accumulated during skeletal development.
Think of it as building a foundation.
The stronger that foundation becomes during childhood and adolescence, the better positioned the skeleton may be to withstand the demands of adulthood and aging.
As a provider, I want you to understand this:
We don’t have unlimited opportunities to build peak bone mass.
An athlete can’t simply assume they’ll make up for years of inadequate fueling once they’re older.
Some aspects of bone health can improve with appropriate treatment and nutritional rehabilitation, but prolonged disruption during critical developmental periods may leave lasting deficits.
That’s why bone health in young athletes deserves attention BEFORE an injury occurs.
Puberty Requires Energy, Not Restriction
During adolescence, the body is doing an incredible amount of work.
- Bones are growing.
- Muscles are developing.
- Hormones are changing.
- The brain is continuing to mature.
- The reproductive system is developing.
All of those processes require energy and nutrients.
Now imagine an athlete who is intentionally restricting their intake because they’ve been told that losing a few pounds might help them run faster, jump higher, or look more athletic.
Their body still needs to support all those developmental processes, but now it has fewer resources available to do so.
When energy intake isn’t sufficient to support both exercise and the body’s other physiological needs, the athlete may experience low energy availability (LEA).
And when that energy deficit contributes to impaired physiological function, it can lead to Relative Energy Deficiency in Sport (REDs).
This is where the consequences can extend far beyond performance.
Low energy availability can affect hormonal function, recovery, immune health, and bone remodeling.
In a growing athlete, it may also interfere with normal skeletal development.
The body can’t prioritize optimal growth and development when it doesn’t have adequate resources to support them.
What Happens When Training Increases but Fueling Doesn’t?
Picture a high school athlete heading into a new season.
Their training volume increases.
Practices are longer.
They start lifting more frequently.
Maybe they’re adding extra conditioning sessions because they want to earn a varsity spot.
But their food intake?
That stays about the same.
Or worse, they start eating less because they believe a lighter body will improve performance.
This is where low energy availability can develop, even when an athlete isn’t intentionally restricting food.
Their energy needs have increased, but their intake hasn’t kept up.
And the consequences aren’t always immediately obvious.
The athlete may still be performing well.
They may even be setting personal records.
But underneath those performances, their body may be struggling to keep up with the demands being placed on it.
Bone remodeling can become compromised.
Hormonal function may change.
Recovery may decline.
And eventually, we may begin seeing recurrent injuries, fatigue, or other signs of REDs.
This is why I want providers and coaches to stop assuming that improving performance automatically means an athlete is adequately fueled.
An athlete can perform well for a period of time despite underfueling. That doesn’t mean the situation is sustainable.
Menstrual Dysfunction Isn’t “Normal for Athletes”
This is one of the biggest red flags we simply can’t afford to normalize in young athletes.
How many times have we heard something like:
“She doesn’t get her period because she runs so much.”
“It’s normal for competitive athletes to have irregular cycles.”
“Her period will come back when the season ends.”
No.
Menstrual dysfunction should not automatically be dismissed as a normal consequence of training.
Estrogen plays an important role in bone health by helping regulate bone resorption and maintain bone mineral density.
When low energy availability disrupts reproductive hormones, the consequences can extend beyond the menstrual cycle.
A missing period isn’t just a reproductive concern. It can also be a clue about what’s happening with bone.
During adolescence, when the skeleton is still developing, that becomes especially concerning.
Of course, menstrual cycles can be irregular during the early stages of puberty, and not every irregular cycle is caused by low energy availability.
But persistent menstrual dysfunction deserves appropriate evaluation rather than being brushed off because an athlete trains hard.
And let’s not forget male athletes.
Low energy availability can also affect testosterone and other hormones involved in bone development and maintenance.
REDs isn’t exclusive to female athletes, and neither are its potential consequences for bone health.
Why Weight-Loss Recommendations Can Have Unintended Consequences
Here’s where I think we need to be particularly careful as adults working with young athletes.
We live in a sport culture that often associates leanness with performance.
We hear things like:
- Lighter is faster.
- Less body fat means better conditioning.
- A certain body type is better suited for a particular sport.
And those messages can start incredibly young.
Sometimes they’re communicated directly through weight-loss recommendations.
Other times, they’re communicated indirectly through comments about an athlete’s body, comparisons with teammates, or praise when someone becomes leaner.
But what happens when a growing athlete starts restricting food to achieve a particular body size?
They may reduce the energy available for growth and skeletal development.
They may eliminate foods or food groups that provide important nutrients.
They may begin ignoring hunger cues.
And they may develop a relationship with food and their body that’s driven by fear rather than performance and health.
All in pursuit of a number on the scale or a particular appearance.
A lower body weight isn’t automatically a healthier or better-performing body.
And in adolescence, the cost of pursuing weight loss can be particularly high.
We need to be very careful about recommending body composition changes without considering the athlete’s developmental stage, nutritional status, training demands, and overall health.
Because the body we’re trying to make “better” for sport is still being built.
Keep Them on Their Curve
This is one of the concepts I emphasize in my book, The RED-Solution.
Keep them on their curve.
When we’re working with growing athletes, we need to think about their individual growth and development trajectories.
Young athletes are supposed to grow.
Their bodies are supposed to change.
Their weight may increase as they gain height, muscle, bone, and other tissues.
That’s not a problem to fix. It’s part of normal development.
Instead of focusing on achieving a particular weight or body composition, we should be asking whether an athlete is progressing appropriately along their individual growth curve.
Are they continuing to grow as expected?
Are they moving through puberty appropriately?
Is their nutritional intake supporting those changes?
Have there been unexpected shifts in their growth trajectory?
A teenager whose weight remains stable while their training demands and developmental needs increase may not be adequately fueled.
An athlete whose weight is considered “normal” can still experience low energy availability.
Weight stability doesn’t automatically mean an athlete is healthy.
This is why growth charts, developmental history, and changes over time can provide important information that a single weight measurement cannot.
We need to look at the trajectory, not just the number.
Calcium and Vitamin D Can’t Make Up for Chronic Underfueling
When a young athlete experiences a stress fracture, one of the first nutrition recommendations they may receive is to increase calcium and vitamin D.
And yes, those nutrients matter, but as I discussed in my recent article on athlete bone health, calcium and vitamin D are only two ingredients in a much bigger recipe.
Bone formation requires adequate energy, protein, carbohydrates, and a variety of micronutrients.
When an athlete is chronically underfueled, the body may not have the physiological resources necessary to support optimal bone remodeling.
That’s why simply adding supplements to an inadequate diet doesn’t address the underlying problem.
You can’t supplement your way out of chronic underfueling.
If a young athlete is experiencing recurrent bone stress injuries, we need to investigate WHY their bones may not be adapting appropriately to training.
- Is their intake keeping up with their activity?
- Are they restricting foods?
- Are there signs of hormonal disruption?
- Are they recovering adequately?
- Are they progressing appropriately through growth and development?
Because the answer may involve much more than a calcium supplement.
The Consequences May Last Beyond the Playing Years
This is probably the part of the conversation that concerns me the most.
When we identify REDs and restore adequate energy availability, many of the associated physiological consequences can improve.
Hormonal function may recover.
Energy levels may improve.
Training tolerance may increase.
But bone health can be more complicated.
If prolonged underfueling occurs during critical periods of skeletal development, an athlete may not achieve the peak bone mass they otherwise could have.
And those missed opportunities may not be fully recoverable later.
Think about that for a second.
We’re talking about teenagers who may be making decisions about food and body composition based on how they want to perform this season.
But the consequences could affect their skeletal health long after their competitive careers end.
The goal isn’t just to help young athletes perform well today. It’s to protect their ability to remain healthy and active for decades to come.
That’s why early identification and intervention matter.
We shouldn’t wait until a young athlete has experienced multiple stress fractures before we start asking questions about fueling, growth, hormones, and recovery.
What Should Parents, Coaches, and Providers Focus On Instead?
If we’re going to move away from weight-focused messaging in youth sports, we need to give athletes something better to focus on.
And there are plenty of things that matter far more than chasing an “ideal” body composition.
Growth and Development
Is the athlete progressing appropriately through puberty and following their individual growth trajectory?
Changes in growth patterns deserve attention, especially when accompanied by restrictive eating, high training demands, or other REDs symptoms.
Adequate Fueling
Is the athlete consuming enough energy to support training, recovery, and normal physiological development?
Remember, young athletes aren’t only fueling exercise.
They’re fueling growth.
Recovery
Are they getting enough sleep?
Do they have adequate rest between training sessions?
Are they recovering appropriately from practices and competitions?
Hormonal Health
Are there changes in menstrual or reproductive function?
Are there other signs that hormonal development or function may be disrupted?
These aren’t symptoms to normalize simply because an athlete is competitive.
Strength and Performance
Instead of focusing on how much an athlete weighs, let’s pay attention to what their body can do.
Are they developing strength?
Building skills?
Adapting to training?
Recovering appropriately?
Staying healthy enough to participate consistently?
Performance is influenced by far more than body weight or body composition.
Their Relationship With Food and Their Body
Are we teaching young athletes to fuel their bodies?
Or are we teaching them to fear normal growth and development?
The language we use around food, weight, and performance matters.
And the adults surrounding young athletes have an important opportunity to help shape those messages.
We’re Building More Than Athletes
I understand why young athletes want to improve.
They’re competitive, motivated, and want to make the team, earn the scholarship, set the record, or reach the next level.
As providers, coaches, and parents, we want to help them succeed.
But we can’t become so focused on the next performance milestone that we overlook what’s happening inside their growing bodies.
A teenager isn’t a finished product that needs to be made smaller, leaner, or more “ideal” for sport.
They’re still developing.
And the choices we make around fueling, training, recovery, and body composition can influence that development.
So instead of asking how we can make a young athlete lighter, let’s ask how we can help them become stronger.
Instead of focusing on a particular body-fat percentage, let’s focus on adequate energy availability.
Instead of normalizing missed periods or recurrent injuries, let’s investigate what those symptoms may be telling us.
And instead of prioritizing this season’s performance above everything else, let’s remember the bigger picture.
We’re not just helping young athletes build their athletic careers. We’re helping them build the bodies they’ll live in for the rest of their lives.
Learn More About REDs and Bone Health in The RED-Solution
Bone health is just one example of how low energy availability can affect an athlete’s health, development, and performance.
And it’s one of the reasons I wrote my new academic book:
The RED-Solution: An Evidence-Based Guide to Identifying and Overcoming REDs
In the book, I explore the interconnected physiological systems affected by REDs, including bone health, hormonal function, gastrointestinal health, and more.
My goal is to help providers move beyond individual symptoms and understand the bigger picture so they can identify concerns earlier, ask better questions, and support athletes more effectively.
Because when we’re working with young athletes, we have an opportunity to do more than address the injury or symptom in front of us.
We have an opportunity to protect their long-term health.